Healthcare Provider Details

I. General information

NPI: 1760501662
Provider Name (Legal Business Name): ABBAS A JOWKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABBAS A JOWKAR M.D.

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LEAHY ST STE 401A
MUSKEGON MI
49442-5547
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-4243
  • Fax: 231-727-4214
Mailing address:
  • Phone: 231-672-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number4301096888
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301096888
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number4301096888
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number236990
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: